中国人脑静脉及静脉窦血栓形成的临床特点

Clinical Characteristics of Cerebral Venous Sinus Thrombosis in Chinese

目的分析中国人脑静脉及静脉窦血栓形成(CVT)的临床特点,以提高国内脑静脉及静脉窦血栓形成的早期诊断率,减少误诊率及死亡率。方法对我国1998～2006年文献报道的461例CVT患者的病因、临床表现、影像学特征、治疗经过及预后进行回顾性分析。结果CVT发病年龄多在20～40岁,多数为急性或亚急性发病。其病因中,继发于感染病灶的占18%;非感染性原因占60%左右,其中产褥期发病占39.7%。上矢状窦血栓形成是最常见的CVT。CVT主要临床表现:头痛占88%,视乳头水肿占48.9%,局灶性或全身性的癫占27.6%,神经系统局灶体征占21.6%和意识障碍占18.5%。目前抗凝溶栓治疗是比较公认的治疗CVT的方法,可使CVT的死亡或完全致残率下降15%,超过80%的患者可以存活,但仍有13%～20%的患者死亡。结论中国人CVT的临床表现变异很大且缺乏特异性,常见于育龄期妇女。因此,关注患者是否存在CVT发生的高危因素,尽早行颅脑CT、MRI、MRA或DSA检查,明确诊断后应积极地抗凝治疗,并纠正病因、对症治疗。溶栓联合介入治疗可能具有更好的临床前景。

Objective To summarize and analysis the clinical and imaging features of cerebral venous sinus thrombosis(CVT) in Chinese, as well as to increase the early diagnosis rate and decrease the misdiagnosis and mortality rates of this disease in practice. Methods We took a retrospective analysis on the causes, clinical symptoms, imaging characteristics, treatments and prognosis of 461 CVT patients reported in papers from 1998 to 2006. Results The CVT often occurred in patient with 20-40 year-old especially during puerperium, mostly acute or subacute onset. The causes included infection(18%) and noninfection(60%). In most patients, thrombosis occurred in superior sagittal sinus. The common clinical characteristics were headache(88%), optic papilla edema(48.9%), some accompanied with focal neurological impairment(21.6%), seizure(27.6%), or conscious disturbance(18.5%). Anticoagulation and thrombolysis were the recommended therapeutic methods and the total effective ratio accounted for decreasing death or disability was about 15%. However, there was 13%-20% death rate. Conclusion The symptoms and clinical course of CVT are very different and nonspecific in Chinese thus it induces a high rate of misdiagnosis. We should pay more attention to the patients with high risk of CVT, and immediately undertake the examination of computed tomography(CT), magnetic resonance imaging(MRI), magnetic resonance angiography(MRA) and even digital subtraction angiography(DSA) in order to make a definite diagnosis. It is essential to treat with anticoagulant after the diagnosis of CVT. Thrombolysis association with interventional radiology may be more effective.